Thursday, January 29, 2015

Open season

In the last month, 2 doctors have been shot & killed, on the job, here in America.

I'm not going to say medicine is more dangerous than, say, police, fire, or military work. But it's certainly not safe, either. Both of the doctors who were killed were in hospitals at the time. One shot by a disgruntled patient, another by the upset son of a patient.

2 doctors in a month may be only a drop in the bucket in a country where 82 people are murdered with guns every single day, but it still scares the crap out of anyone trying to help patients, not to mention the affects on our families.

Do I get threatened? Yes. Sadly, all doctors and nurses do. People want to feel better. Or be cured of something. Or want more narcotics. Or are unhappy with my telephone system. So they yell and scream, and sometimes threaten. Most of them simply change doctors and a few may post a shitty review of me online. Generally that's as far as it goes.

But that doesn't mean it might end there. All it takes is one person who goes over the edge. And, here in the land of the gun, firearms are easily obtainable by anyone. Even those who hear voices telling them to kill people. Or have a history of violence with a restraining order against them. Or have committed felonies. Even for a doctor, it's hard to tell who is or isn't crazy enough to actually carry through on their threats.

The ER docs and nurses are the front-line in medicine. I don't know anyone who works in ER who hasn't been threatened or struck by a patient. Does that surprise you? Then go hang out in any decent sized ER in America and see what really goes on there. I was a 19 year old volunteer the first time I did that, and on my second shift got punched in the mouth by a junkie while I was taking her blood pressure.

Violence against health care workers is so common it's not reported most of the time. Only the fatalities make the news.

There's no easy answer, either. Put guns on ER staff? A lot of what they do is lean over patients, so it would be pretty easy for one, or a family member, to grab it off their belt. And don't ask about hospital security. Well-intentioned, sure, but at many hospitals the security guards are septuagenarian retirees with pepper spray. You think that's going to deter a delusional schizophrenic with a Glock?

That doesn't mean we aren't armed, too. I know plenty of docs who keep guns in their desks. Not automatic rifles with armor piercing bullets and high capacity magazines, just basic handguns. We all hope to never have to reach for it. That said, it won't do us any good, either, if a distraught and armed patient catches us up front reviewing lab reports. Or talking to a drug rep. Or heading down to our car.

Dr. Pissy has carried a Beretta under his white coat for as long as I can remember. If you don't think your doctor would keep a firearm in his or her office, think again. Like lawyers and university professors, we have our share of the irrationally angry, and we're easily accessible. Those "gun free zone" signs in front of hospitals and schools don't intimidate anyone determined to wreak havoc. And the laws your state might pass making it a felony to assault a healthcare worker aren't going to bother those who are most likely to do so.

For the record, I have plenty of patients who carry guns to the office (including a police officer who accidentally left it on my exam table overnight and I still give him shit about it). It doesn't bother me, either. They're responsible people (except for you, Officer JT) who happen to carry a gun with them and today have a doctor's appointment, as opposed to someone who brings the gun to the doctor's meaning to use it.

Would it protect me and my staff if Pissy and I had obviously displayed sidearms? Maybe... But on the other hand, a key part of medicine is putting the patient at ease, so you can gain their trust and help them. Plenty of people are not going to open up under that circumstance, which defeats the whole point of the visit. Not to mention all the people who let their rugrats run amok in our office and play with whatever they find

Some are going to take this post as saying I'm a gun nut, who thinks everyone should carry a piece. I didn't say that at all.

Others will take it to mean I'm an anti-gun person, who wants them all banned. I didn't say that either.

My point is this: your doctors, nurses, and pharmacists, regardless of where they work, are doing a damn dangerous job. All it takes is one irrational person with an easily-acquired weapon. And there's no easy way to prevent it, either.

Doctors, unfortunately, are easy targets. We're vulnerable, because what we do best - helping others - means that we're also putting our trust in them not to harm us, too. Trust goes both ways. To get you to confide in us, so we can examine you and figure out your problem, means you have to trust us. At the same time we assume that we can trust you in return. This arrangement works out well, tens of thousands of times a day around the world.

But in the last month 2 good doctors did their best to help and trust others. And paid for it with their lives.


Anonymous said...

Guns should be illegal. There i said it. Yes i am anti-gun. We teach our children to use words, not their hands, when they are upset and angry. Adults should be held to a higher standard. Giving crazy and pissed off people an easier option than words is just asking for trouble.

2nd Amendment Supporter said...

Another liberal anti-gun site comes out of the closet. Thanks for clearing that up, Dr. Grumpy. I can take you off my reading list now.

Anonymous said...

Hey look, two people already didn't hear what you said, one on each side.

Officer Cynical said...

Trust me: Gun laws of any kind mean nothing to those who want to use one to commit crimes. I see it all the time. I believe CCW is the best we can do - allow people to carry if they want to, provided they can get past some reasonable filters. But crooks are always gonna get and use guns, because they're crooks.

Mal said...

America has the highest level of gun violence outside actual warzones.

In the uk, it's knives that are the headlining crime of violence. But way, way less deaths. Why? Close range, risk to attacker, and carrying knives is mostly illegal, so there just aren't as many people carrying them.

America's laws mean anyone can get a gun, legally or illegaly, and kill with it. The only way to stop that, is to collect 99.9% of the guns, destroy them, and stop producing them in quantity.

Packer said...

My daughter the RN, having just completed training in ER , and hearing of a fall that rang my bell and put me in ER asked: How did they treat you in ER ? They were great she was told. She seemed surprised and asked why did I think that was. It was simple, I fell, went home took a shower, had my wife drive me who could help with insurance questions etc, I was not on any drugs, I was not drunk and I am not stupidly aggressive and I was the only one there who was in that condition. Oh, I see she replied. ER's can be nightmarish for staff.

Bobbi said...

Second Amendment Supporter, you seem to have read an entirely different article than I did.

Dr. Grumpy, thank you for your balanced and thoughtful view. To use the Facebook phrase, "it's complicated."

May the two doctors -- and all victims of violence -- rest in peace.

clairesmum said...

Responsible gun ownership is not a problem, as far as I am concerned. The human tendency to forget about the weapon allows those circumstances where tragic events occur. How to keep up the safety awareness over time, and how to convince a responsible gun owner who is in crisis of some sort to temporarily give up the gun for a while are 2 strategies that we don't have and need to figure out.

Packer said...

PS: Just be glad you are not responsible for Go Daddy Super Bowl Commercials , not that is a real dangerous job.

Bobbi said...

Sorry, my mind wandered and I didn't finish one thought...

The most disturbing thing about your comment, Second Amendment Supporter, is your total rejection of everything that someone might do or say because you think you disagree on one subject -- in this case, a subject that has never been mentioned before on this blog and probably won't be again. That's exactly the kind of reaction that is creating increasing polarization in this country.

Kassy said...

I think the GoDaddy ad exec should get a huge raise. The ad will never even actually air and it is and will probably remain the most talked about ad of the Super Bowl. You cannot buy publicity like that.

Anonymous said...

I work in a pharmacy, and have for many years. When I was still a technician I decided to get a concealed carry permit. After work one day, still in my scrubs, I went to apply. Two law officers were there and went through the standard questions: "What do you need it for?" The second officer, noticing my scrubs, answered before I could: "Are you kidding me? Anyone in healthcare oughtta be carrying a gun, they deal with just as many psychos as we do!"

Anonymous said...

Well said, Dr. Grumpy. What a tragic loss. I am a packing pharmacist after 9 pharmacy robberies in less than 3 months. I pray I never have to pull it.

Ms. Donna said...

Thank you for trying to strike a balance. The first two posters saw what they wanted to and reacted accordingly.*sigh*

The issue of weapons/guns (I use the term my father and brother, both military men taught me, "weapon.") is complex. Yes, having a weapon will make me feel invincible (or less "vinciable.")BUT what if I use it and something goes wrong? What if I hurt someone I did not intend to? Even with the best training and will things go wrong. And even if I stop (kill) someone who meant harm, how will I feel?

Could the doctors who were killed stopped their attackers? I do not know. Does anyone?

First step: I think the "guards" in the EDs should be armed. Yes, there is a place for the older guys with pepper spray and a direct line to law enforcement, but a few should have something stronger. These guards should be THROUGHLY trained and tested and paid accordingly (I can hear hospital adminis screaming now). Maybe not all of these advanced guards need firearms. Would tasers work? I don't know. What say law enforcers?

AS for medical personnel, Grumpy is right -- someone leaning over a pt is asking to have a weapon taken. BUT, there are other places to holster a weapon. Think small of back or ankle for starters.

As for weapons in the desk, OK. Just don't let me know it's there. I hope the rest of the office staff knows it is there and have some training.

Now, I am going to have a small cry that places and people dedicated to healing have to worry about nuts with weapons. And have or are thinking of taking up weapons themselves.

Anonymous said...

Happens to veterinarians too :-(

tbunni said...

Receptionists worry too. In clinics they are the first face the patient sees. Sure, some have a particular doctor they are after, but sometimes it's just whoever represents the practice they are angry with. And don't forget that many of our shooters have mental health issues, so logic need not be present.

Keep yourself safe, Dr. Grumpy, and give Mary a raise.

Anonymous said...

One of my pharmacist friends was killed nearly 10 years ago by a patient who was upset by how she was treated several days before. We often we have no control over insurance or physicians who write the scripts. It is scary how one interaction can lead someone to take a life.

Anonymous said...

Fun fact - I work in the power in generating power. Since 09/11, I come to work thinking I've entered some weird demilitarized zone on a daily basis, and since I'm front and center to the first nutcase that decides to create a name for his/herself...well, I'm not saying I'm prepared and I'm not saying I'm not.

I'm saying we live in a very different world than the one I grew up in and while some jobs you expect have inherent risks, you'd be surprised at the jobs you don't expect to carry those risks...but do.

Anonymous said...

Working in healthcare really put my insular life in focus. Too many people really have no idea what "the public" is like. Here's a few of the thoughts I had in my 6 month tenure:

1. want ME to call your doctor for a new script? That idea had never, ever occurred to me before I started as a Pharmacist. I always it was my responsibility to manage my health care. It's different now with EHR's, but still...

2. Am I in some kind of a alternate universe or did that person REALLY speak to me that way? It is AMAZING what comes out of people's mouth. Before working in health care, I thought there was some kind of universal code of conduct. There is not.

3. When I was 8 months pregnant and a patient got angry when I refused to fill his Norco early, he started picking up stuff from the otc aisle and chucking them at me.

4. When I was an intern and someone picked up the cash register and threw it at the tech - same reason as #3, I thought a lot about the fact that there is a subway station just outside the door. They installed bullet-proof glass the next day.

As a sidenote, I have nothing against hunting. The ONLY time I have allowed my kids to handle a gun was in Europe under the careful eye of Uncle Vincent, an avid hunter. It is an important part of their way of life and I would never seek to take that away from them. Still, I see no reasonable purpose for allowing assault weapons to John Q's a recipe for disaster.

Anonymous said...

I live in England. I can't believe Americans carry around guns for self-protection. That is all.

Anonymous said...

It is very sad that it has come to this (doctors carrying guns) in the USA. I would not want to work in health care there. Although Canada is far from perfect, I do not fear someone shooting me. I am so grateful for this.

Anonymous said...

Recently at a hospital outside of Philadelphia a physician had a patient pull a gun on him in the office and start shooting. Killed one person. Luckily the physician had a gun in his desk drawer and fired back, then detained the assailant.

Anonymous said...

What is disturbing to me is how much anger people feel. It seems that sometimes people respond to the slightest frustration by lashing out. How did we get to this point?

The knee-jerk response of the second amendment comment is a related form of irrationality: an immediate, emotional response based on a misreading of the original post.

Anonymous said...

I thank you Dr. Grumpy for choosing a well reasoned discussion for this topic. Too many people get guns for protection without proper training.

My husband is weapon safety instructor, retired military, and a gunsmith. He works with Boy Scouts for most of his instruction. We both believe in ethical hunting. We try to know every thing about any weapon in home, and they are all secured in a manner visitors don't know we own them.

I carried a gun to work in a former job. I worked in a bad part of a city near a bus station at a law firm. I was subject to threats that would curl the hair of many. Yes, I did fear for my life at times. I started carrying the gun on the advice of a responding officer.

We moved from that area, and I hope to never have to carry a gun like that again. It takes away the pleasure of target shooting and the like.

Bobbi said...

I don't understand why several people have now commented that the first TWO posters misunderstood Dr. Grumpy. The first poster, Anonymous, did not say Dr. Grumpy said guns should be illegal; she (or he) said she thinks guns should be illegal. She didn't misunderstand a thing.

One of the Anonymouses said, "What is disturbing to me is how much anger people feel." Amen!

peace said...


stacey said...

I did not take your post as anti gun at all.

I own a gun. However...
Horrible, unpredictable things happen. We can't wish them away, we can't secure ourselves enough, and despite lawsuits, and we can't anticipate every possible, bad scenario. Measures will be taken that will be completely useless the next time someone takes a mind to commit evil. Hospitals all over the country are now implementing "Active shooter policies and procedures". Like that will help. It won't, but it keeps the lawyers happy. Because, in the end, you can't prevent everything, only dole out liability, based on the false notion that somehow negligence is involved when a tragedy is not prevented.
Even if that doctor had been carrying a gun, unless he was walking around with it in his hand, it would not have saved him because the criminal had the element of surprise.
After tragedies like these shootings, or say, school shootings, everyone asks how we can prevent this from happening again...the scary truth is, we can't, for the most part, without living in a completely locked down society, and even that won't guarantee any safety...People scream to make guns illegal. How will it help? Drugs are illegal, the laws do not stop people.
It was illegal for him to be carrying the gun where he was. It matters not. Laws can't protect you.
Only behavior or actions can.

The problem is that no one in the public realm will admit this. We like to think we have control but we don’t. We have always had to rely on our fellow human beings to do the right thing. There are just fewer and fewer people with a strong moral compass, or too many mentally ill people, drugged out and disconnected from reality by psychotropic medication, that these instances are on the rise.
We have always had the guns; it was not until recently however, that we have had so many depraved souls walking around on the edge of acting out their maniacal fantasies in such similar patterns. Whether it's because we have had more people with a stronger sense of right vs. wrong in the past, or at least the self discipline and restraint, unadulterated by psychotropics, to not do what their emotions may have urged them to do, it's hard to say.
This much is true...On any given day, we have to hope and trust that the car coming head on at us down the road does not cross the double yellow line, whether due to negligent behavior, accident or malicious intent...we must trust that the bus driver doesn't flip out and drive the bus off a cliff. We pray that the pilot flying the plane isn't suicidal that day...and so on... These occasions, while rare, make us fully aware of our powerlessness, of our lack of control. The first knee jerk reaction is to reach for more control, i.e. legislation, automation and restriction. But if anyone was really honest they would realize that more laws don't put us more in control. They are merely a feeble attempt at reaching sterile perfection.

Anonymous said...

I'm curious as to where your facts come from. in 2012, there was a TOTAL murder rate of 14,827, that's ALL murders, committed by guns and other means. So how do you come up with 82 murders committed by guns EVERY DAY? That would be 29,930 murders in a year. Something doesn't compute.

Anonymous said...

Thanks for your thoughtful essay on this sad topic today, Dr. G.

I wonder when this violence and rage is going to end, and what will be required to turn the corner.

My guess is that for this problem to keep from getting out of hand, that eventually something will be organized to effectively quarantine those with untreated mental illness such as rage issues and unresolved grief, and the concept (and diagnosis) of addiction will be somehow be destigmatized and effective treatment available and administered, as well as enforcement of better controls for access to weaponry.

My father was a school teacher, and the most gentle and kindest, patient teacher that I knew. However, he was pistol-whipped and lost part of an ear when a deranged and former student who recognized him attacked him at another place.

May the souls of the departed find rest as their families heal in their grief.

ASM826 said...

It's not just guns. It's knives, too.

Grumpy, it may not be for everyone, but have you considered some martial arts training? I gave up playing racketball about 8 years ago and took up a fighting art. I've lost about 30 lbs., train three nights a week and have even begun to think I might be able to use it in some fashion if the need arose.

I'm not anti-gun, but as you point out, you just don't have it with you all the time, and if it's visible, it's going to affect some patients. A defensive art is invisible and always with you, at work, in the airport, etc.

Hattie said...

Hawaii has the least gun ownership of any state and the second lowest gun murder rate in the country.

Anonymous said...

Definitely happens to veterinarians too...

Anonymous said...

Where does all the out-of-control rage come from? Is it unique to the United States? A coworker once said he was going to pour gasoline on me and light me on fire. This is bizarre behavior! Thanks, Dr. Grumpy, for calibrating your readers to reality.

Glen said...

The last statistics I saw showed Pediatricians (and peds office staff) as the most likely to be assaulted.

That seems reasonable with both the emotions of dealing with children, and the high percentage of female docs in that field.

A good hospital chaplain service is probably the best way help families deal with the realities of bad outcomes.

Inside the clinic, locked doors and properly escorting patients are helpful. The presence of a large and fit person on the office staff may also help limit outburst.

It is not just a US problem, as there have been many assaults on medical staff in China in the past couple of years.

Life Student said...

Thank you Dr. Grumpy for your perspective. I find it amusing that some people think shaking their heads in disapproval of violence will somehow keep them safe from the reality of truly dangerous situations.

RehabRN said...


I work in an area at the Hotel (which has large signs forbidding weapons) that is high traffic. I often see the disgruntled coming and going.

It took YEARS to convince management that I needed a panic button, as our clinic staff has (after they were threatened 1 time too many). I finally got one when I had a character sneak up behind me and scare me to death. Thankfully, he was harmless and not psychotic at the time.

My boss doesn't like my desk, so sometimes, I am forced to close my door.

Every day I keep it open, I realize that I could be the first one who gets it if a nut comes in guns blazing.

I do my job anyway.

Anonymous said...

As a pharmacist, I have worked with several people who carry firearms discretely irregardless of facility rules. The daily encounters can be fightening and safety concerns exist. I can't imagine joining them, but I'm not certain I could condem them either.

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